The Hertel Report

A Value-Based Approach to Healthcare: 4 Steps to Success, New Supercharged Data Sharing & Boosting Payer/Provider Collaboration

National News

Arizona News

Issue Brief: States Mental Health Protection Laws – A Complex Landscape

The Mental Health Parity and Addiction Equity Act is a critical federal safeguard, ensuring Americans do not face greater challenges in accessing behavioral health services than they do for other medical care. Enforcing this law presents complexities, leading to inconsistent compliance among health insurers. While federal law mandates...

News

Report: U.S. Spends More on Healthcare, Falls Short Compared to Other Countries

A recent report highlights the disproportional high expenditures on U.S. healthcare and how America stacks up to comparable wealthy countries. The U.S. spent approximately $12,742 per person, whereas Switzerland, the second-highest spender, allocated $9,044 per capita. With the U.S. excluded, the average for comparable counties was...

Arizona News

Steward’s Quagmire: Hospital Seized, Another Shut Down, CEO faces upcoming Senate Hearing

This week, Arizona state officials ordered St. Luke's Behavioral Health Center in Phoenix to suspend operations following severe facility deficiencies, including a catastrophic failure of its air conditioning system, which led to dangerously high temperatures, forcing the relocation of approximately 100 psychiatric patients. The Arizona...

Arizona News

MA Newcomer Devoted Health Raises $287M In Funding

Devoted Health has grown from serving 142,124 members in December 2023 to 227,141 members as of July 2024 – up 60%  in just seven months. In Arizona, Devoted Health has about 20,000 Medicare Advantage members in 4-star plans. This year it bumped its membership rolls an impressive 55%, gaining about 7,000 lives from April 2023 to...

Arizona Bricks & Mortar

Brooks Rehabilitation Partners with Mayo Clinic to Open $70M Phoenix Inpatient Rehabilitation Hospital

The rehabilitation hospital is planned on eight acres adjacent to Mayo Clinic’s Phoenix hospital, near the Arizona State University Health Futures Center. The new hospital has entered into a long-term lease agreement for the property with Pan-American Financial Assistance Foundation with funding arranged and structured by Veyron, a...

Arizona News

NAH Partners with City of Hope to Provide Care Coordination for Complex Cancer Care

This new care coordination agreement will expand Northern Arizona Healthcare's (NAH) services across all of its northern Arizona locations to include consultations and virtual appointments for patients with complex or rare forms of cancer. Patients within NAH's rural service area can now access specialty oncology services through...

Arizona News

'Housing is Healthcare' AHCCCS Selects Solari as H20 Program Vendor

Beginning this fall, Arizona Medicaid members with a serious mental illness (SMI) designation who are experiencing homelessness will be the first to benefit from the effort to enhance and expand housing services and interventions for especially vulnerable members of the Arizona Health Care Cost Containment System (AHCCCS). The...

Arizona News

Walgreens Pharmacy Closures - VillageMD Sale Under Consideration

Walgreens plans to close 25 percent (or 2,100) of its nearly 8,600 stores in the U.S. within the next year and is evaluating whether it will reduce its stake in VillageMD. Since February 2024, 625 Walgreens stores have been shuttered. Walgreens Boots Alliance is exploring the possibility of selling its VillageMD primary care clinics,...

Arizona News

MA Hits Enrollment Milestone - 54% National Penetration

According to a KFF analysis, in 2024, 32.8 million people enrolled in a Medicare Advantage (MA) plan translating to $462B of total federal Medicare spending. MA reported the highest gross margins ($1,982 on average) of any insurance segment by the end of 2023. The rise in MA enrollment can be attributed to several factors, including...

National News

AMA Study: Prior Authorizations Plus PA Delays and Denials Are Costly For Many Americans, Increase Utilization

The 2023 physician survey contradicts health insurance claims that prior authorizations save money. Physicians argue prior authorizations are costly and inefficient, leading to significant expenses for patients, employers, physicians, hospitals, and health systems. This annual survey by the American Medical Association (AMA)...

Arizona News

CVS 2024 Q2 Reports Increased Revenue But Lowers 2024 Guidance Again

CVS Health Corporation's (CVS) second-quarter revenues rose to $91.2 billion, a 2.6% increase from the previous year, primarily driven by growth in its Medicare and commercial businesses. The company still faces ongoing challenges in the healthcare benefits segment. However, these losses were partly mitigated by strong performance...

Arizona News

Steward Health Care Sells Physician Practice Network

Dallas-based Steward Health Care, one of the largest hospital systems to file for bankruptcy in the U.S., has sold its physician practice network, Stewardship Health. Steward has reached a $245 million agreement with Rural Healthcare Group, a portfolio company of private-equity firm Kinderhook Industries, to acquire Stewardship...

Arizona News

Arizona Marketplace & Small Group Insurers Propose Rate Increases

Arizona is designated an effective rate review (ERR) state for the individual and the small-group major medical health insurance markets. See the rate increases requested by insurers planning to offer individual and small group products in Arizona in 2025. The Affordable Care Act requires states to provide certain information about...

National Reports & Surveys

Survey: Americans Struggle With Confusing Medical Claims Appeals Process

A 2023 Affordability Survey reveals significant challenges Americans face with the appeals process for claim denials and billing errors. Patients and their families are confused about their right to appeal and who to contact, and a high rate of successful appeals suggests potential flaws in the initial determination process. Sara...

News

Report: Employer-Sponsored Insurance - 3.2M in Arizona Have Coverage

America's Health Insurance Plans' new report details the vital role of employer-provided coverage (EPC) in America's healthcare system and highlights its provision of affordable (really!), high-quality care to more than 180 million people, including nearly 3.3 million in Arizona. The July report,  Employer-Provided Health...

Harris Picks Walz as VP – A Champion for American Healthcare

Minnesota Governor Tim Walz has demonstrated a strong commitment to healthcare reform throughout his tenure. Besides serving as a "coach" for Democratic presidential candidate Kamala Harris, Walz's belief that affordable medical care is a fundamental right for every American is part of the reason he was chosen to be her running...